Peritoneal dialysis catheters in pediatric patients: 10 years of experience in a single centre

Peritoneal Dialysis (PD) is one of the numerous options for chronic dialysis and in many cases when access for acute dialysis is required early in a hospital course, at any age. PD catheter can be inserted with an open or laparoscopic approach. The complication rate after catheter insertion is still high, as reported in published literature. We present the experience matured at our Centre in the last 10 years on implantation of peritoneal dialysis catheters in children, emphasising surgical complications. We conducted a retrospective study on patients who underwent PD at our Centre in a range period of 10 years. We analysed patients \u2019demographic data, past and present medical, perioperative and post-operative data, permanence of the catheter, duration of dialysis, the gap between placement and use, outcomes and complications. We compared the data, dividing patients in 2 groups: patients operated with a traditional open technique and patients operated laparoscopically. We retrospectively reviewed 29 children with an average age of 3years and 6 months. Mean age was 42 months (1 month; 8 years) for the VLS group, 18 months (11 days, 4 years) for the OT group. Mean operative time was 106 min for the VLS group; 44 min for the OT group. The Catheter permanence period was 17 days (12h-64 days). Duration of dialysis was between 48 hours and 23 days (average 8 days). In the total population, we registered 8 complications (5 minor, 3 major), the overall complication rate being 33 % (minor complication rate 21%, major complication rate 12,5 %). 6 complications occurred in patients operated laparoscopically (6/14 = 36 %); 2 complications in the OT group (2/10 = 20 %). The complication rate after PD catheter insertion is still high. Advantages and disadvantages of the open and laparoscopic approach must be known. Both minor and major complications, such as bowel perforations and occlusions, must be understood and differentiated

Robotic removal of Müllerian duct remnants in pediatric patients: our experience and a review of the literature.

Persistent Müllerian duct syndrome is a disorder of sexual development, which features a failure of involution of Müllerian structures. An enlarged prostatic utricle is a kind of Müllerian duct remnant (MDR) with a tubular shaped structure communicating with the prostatic urethra. Treatment is aimed at relieving symptoms when present, preserve fertility and prevent neoplastic degeneration. We describe 3 cases of successful robot assisted-removal of symptomatic MDRs. The first case came to our attention for pseudo-incontinence; the other two for recurrent urinary tract infections. The patients have not presented such symptoms anymore on follow-up. We then reviewed existent literature on authors who have recently investigated the main issues concerning MDRs and have attempted a roboticassisted approach on them. Robot-assisted laparoscopy can be considered a valid, safe and effective minimally-invasive technique for the primary treatment of prostatic utricle

A unique case of foreign body aspiration and recurrent pneumothorax

Paediatric foreign body aspiration can be related to a high morbidity/mortality rate, especially in young children, and pneumothorax can be a severe associated issue. We describe a case of a 13-year-old girl with recurrent pneumothorax in bilateral bullous lung, twice previously treated at our institution by robotassisted bullectomy, and once again showing same signs and symptoms. At conventional thoracoscopy an inorganic foreign body was found to be located pointing upwards the apex. We believe this may have acted as a contributory cause in the persistence of the clinical picture, despite the surgical removal of the underlying pathology

Female Hypospadias and Urinary Incontinence: Surgical Solution of a Little-Known Entity

Female hypospadias is a rare genito-urinary anomaly, often associated with other congenital malformations of the urinary tract. For female hypospadias it is meant a condition in which the external urethral meatus opens high up in the anterior vaginal wall proximal to the hymenal ring; the urethra is obviously shorter than usual. Embryologically, it is thought to be due to an abnormal development of the urogenital sinus or to a lack of differentiation of Wolff’s tissue. Etiology though still remains unknown. Even though commons symptoms related to female hypospadias include urinary incontinence, recurrent urinary tract infections and dyspareunia, patients are often diagnosed accidentally during catheterization for other reasons. Its detection is simple but often late in childhood or even in adulthood. Treatment can be difficult due to the lack of consistent literature on the topic and also because it requires management of the other associated anomalies. We describe the case of a 5-year-old girl presenting incontinence secondary to hypospadias, successfully treated with a 2-step surgical strategy

Robot-assisted thoracoscopic repair of a late-onset Bochdalek hernia: a case report

Bochdalek hernia (BH) is a major malformation that consists of a postero-lateral diaphragmatic defect through which abdominal contents can migrate into the thorax. It is most commonly a neonatal pathology associated with significant morbidity and mortality. Rarely, this type of congenital diaphragmatic hernia (CDH) presents later in life, some even in adulthood. Indications for surgery are not clear even though the majority of authors, being aware of the possible severe complications, recommend surgical correction in all cases. Many surgical approaches have been tried for this pathology, both open (laparotomic or thoracotomic) and minimally invasive (laparoscopic or thoracoscopic). We report a case of a late-onset BH corrected with a robot-assisted thoracoscopic procedure. The use of robotic technology for CDH has never been described to date

Robot-assisted Pyeloureterostomy in Bifid Renal Pelvis With Ureteropelvic Junction Obstruction of the Lower Moiety

Duplications of the urinary collecting system and pyelo-ureteral junction obstruction (PUJO) are common, but the simultaneous presence of both anomalies is rarely encountered. In incomplete duplicated systems, PUJO usually affects the lower moiety. We present the case of a 5-year old boy with left bifid renal pelvis and hydronephosis of the lower moiety treated by robot-assisted pyeloureterostomy

Feasibility, in terms of efficacy and safety, of video-assisted pyeloplasty (OTAP) in the first 90\ua0days of life

Introduction The uretero-pelvic junction (UPJ) is the most common site of obstruction in the pediatric upper urinary tract, causing hydronephrosis. In our institution, the gold standard approach for hydronephrosis in infants is the One-Trocar- Assisted Pyeloplasty (OTAP). The aim of this study is to evaluate the feasibility of OTAP in terms of efficacy and safety in the first 90 days of life. Methods We retrospectively reviewed all charts and long-term follow-up of 138 infants treated with OTAP; we selected and examined the ones with a defined diagnosis of severe UJPO and, thus, treated in the first 90 days of life: 28 patients. Indica- tions for early surgery were: antero-posterior pelvic diameter (APD) > 20 mm and an obstructive pattern on renography; impaired echotexture and/or relative renal function < 40% had to be associated. Results Out of 23 patients, we witnessed one conversion to open surgery (4.35%) and one recurrence (4.35%) of UPJO. The mean pre-surgery APD was 35.2 mm, while the mean post-surgery APD was 17.32 mm. The mean operative time was 133 min. The mean hospitalization time was 7.71 days. The mean average of follow-up was 46.41 months (minimum 1 year). Conclusions Our experience suggests that OTAP is a valid and feasible technique in terms of safety and efficacy for the early treatment of very young infants affected by UPJO

Uretero-Pelvic Junction Stenosis: Considerations on the Appropriate Timing of Correction Based on an Infant Population Treated with a Minimally-Invasive Technique

Abstract: There is no univocal consensus about timing of intervention and best surgical approach for infants with asymptomatic uretero-pelvic junction obstruction (UPJO). We conducted a retrospective analysis of patients undergoing one-trocar-assisted pyeloplasty (OTAP) in a 13 year range period by creating two homogenous groups (indications for surgery were the same for all patients): patients operated on in the first 90 days of life (34 patients; Group 1) and patients operated on between 3 and 12 months of life (34 patients; Group 2). We observed no statistically significant differences between groups in regard to mean operative time, conversion rate to open surgery, mean hospital stay, early complications (urinary leakage) rate and mean antero-posterior diameter (APD) reduction rate. Moreover, no statistical improvement was seen between groups in regard to separate renal function (SRF) at 1-year-follow-up renogram. Thanks to the HSS calculated before and 1 year after surgery, we registered an important improvement in Group I patients (p = 0.023). In our study, there was no significant evidence, in terms of intraoperative data and early postoperative outcomes, between patients who underwent an early pyeloplasty and those who underwent a delayed correction. Nevertheless, we registered a significant improvement in those patients with an impaired SRF that underwent an early surgical correction, especially in terms of urinary flow. Even though this study cannot definitely establish the superiority of early timing of correction, it is evident that further research is needed to clarify this aspect